Systemic Immune-Inflammation Index and C-Reactive Protein/Albumin Ratio Could Predict Acute Stent Thrombosis and High SYNTAX Score in Acute Coronary Syndrome.

Acute stent thrombosis (AST) is associated with increased morbidity and mortality. The main aim of this study was to evaluate the prognostic value of the systemic immune-inflammation index (SII) and C-reactive protein (CRP) to albumin ratio (CAR) in predicting AST and high SYNTAX score in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). The criteria of the Academic Research Consortium were used to determine definite stent thrombosis. A total of 2077 consecutive patients with ACS undergoing PCI were retrospectively enrolled. Platelet, white blood cell and neutrophil counts, as well as SII, CRP, CAR, and peak cardiac troponin I (cTnI) values were significantly higher, whereas the lymphocyte count and albumin values were significantly lower in the AST (+) group compared with the AST (-) group (P < .05). SYNTAX score showed significant positive correlations with SII (r = .429, P < .001) and CRP (r = .402, P < .001). Multivariate logistic regression analysis showed that SII and CAR, as well as age, diabetes mellitus, stent length, and peak cTnI are independent predictors of AST and high SYNTAX score. In conclusion, the SII and CAR are simple, relatively cheap, and reliable inflammatory biomarkers that can predict AST and high SYNTAX scores in ACS.

Prognostic value of CHA2DS2-VASc score in predicting high SYNTAX score and in-hospital mortality for non-ST elevation myocardial infarction in patients without atrial fibrillation.

OBJECTIVE: To evaluate the prognostic value of preprocedural CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years (doubled), diabetes mellitus, previous stroke or transient ischemic attack (TIA) (doubled), vascular disease, age 65-74 years, female gender] score in predicting high SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score and in-hospital mortality for non-atrial fibrillation (AF) patients presenting with non-ST elevation myocardial infarction (NSTEMI). The CHA2DS2-VASc score used to determine thromboembolic risks in AF was recently reported to predict major adverse clinical outcomes in patients with the acute coronary syndrome, irrespective of AF. METHODS: A total of 906 patients with a diagnosis of NSTEMI who underwent coronary angiography were retrospectively enrolled and divided into three groups according to their SYNTAX scores (low, intermediate, and high). The CHA2DS2-VASc score of each patient was calculated. RESULTS: SYNTAX score had a significant positive correlation with the CHA2DS2-VASc score (r=0.320; p<0.001) in the Spearman correlation analysis. The CHA2DS2-VASc score [Odds ratio, 1.445; 95% confidence interval (CI), 1.268-1.648, p<0.001], left ventricular ejection fraction, creatinine, C-reactive protein, and high-density and low-density lipoprotein cholesterol levels were demonstrated to be independent predictors of high SYNTAX score. The CHA2DS2-VASc score [Hazard ratio (HR), 1.867; 95% CI: 1.462-2.384; p<0.001], the SYNTAX score (HR, 1.049; p=0.003), and age (HR, 1.057; p=0.002) were independently associated with higher risk of in-hospital mortality in a multiple Cox-regression model. Kaplan-Meier survival curves stratified by the CHA2DS2-VASc score (<4 vs. ≥4) also showed that higher CHA2DS2-VASc scores were associated with higher in-hospital mortality. CONCLUSIONS: In non-AF patients with NSTEMI, CHA2DS2-VASc and SYNTAX scores are useful for prognosis assessment and can be used to identify patients at higher risk for in-hospital mortality.

Relationship of serum HLA-B alleles and TNF-α with rheumatic heart disease

Background/aim: Acute rheumatic fever and rheumatic heart disease are major causes of morbidity and mortality in developing countries. Genetic studies have determined that the immune response in rheumatic heart disease is genetically controlled and that there is a close relationship between the gene of concern and the class II human leukocyte antigen (HLA) gene. The aim of this study was to evaluate the relationship of serum HLA-B alleles and tumor necrosis factor alpha (TNF-α) with rheumatic heart disease. Materials and methods: A total of 50 consecutive patients with rheumatic heart disease and 50 controls were enrolled in the study. HLA alleles were analyzed using sequence-specific primer-polymerase chain reaction and nucleotide sequencing. Results: The HLA-B35 allele was significantly more common in patients with rheumatic heart disease than the control group (P = 0.043). The HLA-B44 allele was significantly more common in control patients than in patients with rheumatic heart disease (P = 0.014). There was a significant inverse correlation between high-sensitivity C-reactive protein and mitral valve area (P = 0.001). There was no correlation between TNF-α levels and mitral valve area (P = 0.066). Conclusion: Our findings confirmed the association between HLA-B alleles and rheumatic heart disease.

Analysis of MMP-7 and TIMP-2 gene polymorphisms in coronary artery disease and myocardial infarction: A Turkish case-control study.

Matrix metalloproteinase (MMP) and tissue inhibitors of metalloproteinase (TIMP) have a significant role in tissue remodeling related to cardiac function. In earlier studies, MMP-7 A-181G (rs11568818), C-153T (rs11568819), C-115T (rs17886546), and TIMP-2 G-418C (rs8179090) polymorphisms have been studied in various diseases. However, association between coronary artery disease (CAD) and these polymorphisms has been poorly studied. The goal of this study is to investigate the association of CAD and myocardial infarction (MI) with MMP-7 or TIMP-2 polymorphisms. This study included 122 CAD patients and 132 control individuals. DNA was extracted from whole blood. Polymerase chain reaction-restriction fragment length polymorphism and automated direct sequencing method were used for genotyping of these polymorphisms. No significant differences were found between MMP-7 A-181G, C-115T, and TIMP-2 G-418C polymorphism and CAD or MI in a Turkish population. Despite the fact that the genotypes of MMP-7 C-153T polymorphism had no significant differences among MI and control groups, allele frequencies of C-153T polymorphism were significantly different between the two groups. Our study is the first report to clarify the appreciable relationship between MMP-7 C-153T polymorphism and MI development in CAD patients. However, these findings also need to be confirmed in other populations so we can improve our knowledge about the genetic factors affecting the development of CAD.

Effect of serum YKL-40 on coronary collateral development and SYNTAX score in stable coronary artery disease.

OBJECTIVE: Many studies have revealed a role of YKL-40 as a new inflammatory biomarker in angiogenesis, inflammation, atherosclerosis and cardiovascular events. Thus, the aim of this study was to investigate the association of serum YKL-40 level with coronary collateral development and SYNTAX score in patients with stable coronary artery disease. METHODS: A total of 165 patients who had ≥90% stenosis in at least one major coronary artery were prospectively enrolled in the study. Collateral degree was graded according to Rentrop-Cohen classification. Patients with grade 2 or 3 collateral degree were included in good collateral group and patients with grade 0 or 1 collateral degree were included in poor collateral group. The patients were also classified according to SYNTAX criteria, those with low (≤22) and those with high (>22) SYNTAX score. RESULTS: Serum YKL-40 and hs-CRP levels were significantly lower in good collateral group. Furthermore, YKL-40 level showed significant positive correlations with SYNTAX score (r=0.486, p<0.001) and hs-CRP level (r=0.340, p<0.001). In multivariate regression analysis, serum YKL-40 (odds ratio: 0.928; 95% confidence interval: 0.917-0.940; p<0.001), duration of ischemic symptom and total occlusion were independent predictors of good collateral development. In ROC curve analysis, a YKL-40 value cut-off point of ≥168.5 predicted the high SYNTAX score with a sensitivity of 81.0% and specificity of 72.4%. CONCLUSIONS: Increased serum YKL-40 level was related with poor collateral development and high SYNTAX score. According to these findings YKL-40 can be used as a predictor of good collateral development and high SYNTAX score.

Increased serum YKL-40 level is associated with the presence and severity of metabolic syndrome.

OBJECTIVE: Metabolic syndrome (MS) is defined by a cluster of interdependent physiological, biochemical, and clinical risk factors and linked to a state of chronic inflammation. YKL-40 is known as an inflammatory glycoprotein, which is secreted by various cell lines during inflammation. Thus, we aimed to assess the association of serum YKL-40 levels with the presence and severity of MS. METHODS: In this prospective cross-sectional study, a total of 177 consecutive patients [n=114 MS present and n=63 MS absent] were enrolled. MS was defined according to National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. Serum YKL-40 and hs-CRP levels were measured for all participants. RESULTS: Serum YKL-40, hs-CRP and white blood cell count (WBC) were significantly higher in the MS present group (p<0.05). There was a graded relationship between increasing number of MS components and serum YKL-40 level (p<0.05). In addition, serum YKL-40 level was positively correlated with hs-CRP level (r=0.467, p<0.001) and WBC count (r=0.251, p=0.001). In multivariable regression analysis, serum YKL-40 [1.022 (1.011-1.033), p<0.001] and hs-CRP [1.346 (1.111-1.632), p=0.002] were remained as independent predictors for the presence of MS. In the ROC curve analysis, using a cut-off level of 147.0, YKL-40 well predicted the presence of MS with a sensitivity of 73.7% and specificity of 69.8% (AUC: 0.785; 95% CI: 0.718-0.853, p<0.001). CONCLUSION: In this study, we demonstrated that serum YKL-40 level was significantly associated with the presence of MS. According to these findings, we concluded that serum YKL-40 may be a novel and useful indicator for MS.

The effect of statin treatment on P-wave characteristics and atrial conduction time.

BACKGROUND AND AIM: The aim of this study was to evaluate the effect of statin treatment on P-wave morphology, dispersion, and tissue Doppler imaging-derived atrial conduction time (PA-TDI), which are known to be predictors of atrial fibrillation (AF). METHODS: A total of 132 patients with guideline-directed statin indications but no clinical atrial tachyarrhythmias were studied. P-wave duration, P-wave dispersion, and P-wave amplitude on surface 12-lead electrocardiogram and PA-TDI were evaluated before and after three months of statin (either atrovastatin 10-40 mg/d or rosuvastatin 10-20 mg/d) treatment. RESULTS: Total and low-density lipoprotein cholesterol were significantly reduced after statin therapy. P-wave dispersion significantly decreased from 39.6 ± 9.4 to 36.9 ± 9.6 ms. Statin treatment significantly decreased both the maximum (from 1.5 ± 0.36 to 1.45 ± 0.33 mV, p = 0.001) and the minimum (from 1.07 ± 0.28 to 1.04 ± 0.27 mV, p = 0.01) P-wave amplitude. The PA-TDI value was found to be significantly shorter after statin treatment (121.7 ± 18.7 vs. 118.7 ± 15.8 ms, p = 0.016) CONCLUSIONS: Short-term statin therapy was shown to significantly affect P-wave amplitude, P-wave dispersion, and atrial conduction time in a broad range of patients without any clinical atrial tachyarrhythmia.

Relationship between plasma apelin level and coronary collateral circulation.

OBJECTIVE: Coronary collaterals play a crucial role during an acute ischemic attack. Angiogenesis has an important role in the formation of coronary collateral vessels. Previously, it was shown that apelin is a potential angiogenetic factor. Thus, we aimed to investigate relationship between plasma apelin levels and coronary collateral circulation in patients with stable coronary artery disease. METHODS: Among patients who underwent coronary angiography with stable angina pectoris, patients with a stenosis of ≥90% were included in our study. Collateral degree was graded according to Rentrop-Cohen classification. Patients with grade 2 or 3 collateral degree were included in good collateral group and patients with grade 0 or 1 collateral degree were included in poor collateral group. RESULTS: Plasma apelin level was significantly higher in good collateral group (0.69 ± 0.2 vs 0.59 ± 0.2 ng/dl, p < 0.001). Serum nitric oxide levels were similar between two groups. In multivariate regression analysis apelin [6.95 (1.46-33.15), p = 0.015] and presence of total occlusion [4.40 (1.04-18.62), p = 0.044] remained as independent predictors for good coronary collateral development. CONCLUSIONS: Higher plasma apelin level was related to better coronary collateral development. Demonstration of favorable affects of apelin on good collateral development may lead to consider apelin in antiischemic treatment strategies in order to increase collateral development.

A shift in the balance of regulatory T and T helper 17 cells in rheumatic heart disease.

BACKGROUND: Autoimmunity plays an essential role in the pathogenesis of rheumatic heart disease (RHD); however, cellular mechanisms of autoimmune response are unclear. Whereas T helper 17 (TH17) and regulatory T cells (Treg) cells share a common differentiation pathway, they play opposite roles in the immune tolerance and autoimmune diseases. Although high TH17/Treg ratio has been shown in several autoimmune diseases, no data are available in RHD. This study investigated the balance between TH17 and Treg in rheumatic mitral valve disease (MVD). METHODS: Forty patients with rheumatic MVD and 23 control subjects were enrolled into the study. All subjects underwent clinical, electrocardiographic, and echocardiographic evaluation. The percentages of circulating TH17 and Treg cells were analyzed by flow cytometry. Serum levels of high-sensitivity C-reactive protein (hs-CRP) and cytokines were assessed by enzyme-linked immunosorbent assay. RESULTS: As compared with control subjects, rheumatic MVD patients showed significant increase in peripheral TH17 percentage, high serum levels of TH17-related cytokine interleukin 17A, and an obvious decrease in the percentage of Treg cells. T helper 17/Treg ratio was significantly high in rheumatic MVD patients compared with control subjects (P = 0.0001). Serum concentrations of hs-CRP in rheumatic MVD group were higher than those of the control subjects, and hs-CRP levels correlated with the TH17/Treg ratio (r = 0.71, P = 0.0001). Serum levels of transforming growth factor ß1 were increased in rheumatic MVD group compared with those of the control subjects. CONCLUSIONS: The results indicated that high TH17/Treg ratio exists inrheumatic MVD. This imbalance may play a role in the pathogenesis, and TH17/Treg balance may be a promising therapeutic approach in RHD.

[Oral antiplatelet therapy in the treatment of acute coronary syndrome]. / Akut koroner sendrom tedavisinde oral antitrombosit tedavi.

In recent years, there have been rapid developments in cardiology, particularly regarding the diagnosis and treatment of acute coronary syndromes (ACS). In this article, we reviewed the position of oral antiplatelet therapy in current guidelines. Since plaque rupture in ACS leads to a contact between atheroma content and platelets, resulting in rapid platelet aggregation and formation of thrombus plug, the ACS treatment must provide an effective inhibition of platelet aggregation. Therefore, dual antiplatelet therapy with aspirin and a P2Y(12) inhibitor is the cornerstone of ACS treatment. The fact that the genetic and pharmacokinetic properties of clopidogrel, a P2Y(12) inhibitor, cause insufficient antiplatelet efficacy and inadequate offset of action has led to the introduction of new P2Y(12) inhibitors such as prasugrel, ticagrelor and cangrelor, which offer an improved antiplatelet efficacy with a bleeding risk within acceptable limits. Prasugrel, which is currently approved in Turkey, is used in ACS only for percutaneous coronary intervention (PCI) in the patients with a known coronary anatomy and without an intended bypass surgery. It has been found prasugrel is found to be efficient in the diabetic patients and for the prevention of subacute thrombus. However, it has limitations such as being contraindicated in the patients with a TIA history, and recommended not to be used (or used with dose reduction) in the patients above the age of 75 years and those with a body weight less than 60 kg. The other approved agent in Turkey is ticagrelor. It allows starting treatment without coronary angiography and can be used in a wide spectrum including PCI and medical treatment, and decreases mortality, all of which are advantages; however, it causes dyspnea in some patients and is dosed twice daily, which are considered as limitations. The widespread use of new P2Y(12) inhibitors in daily practice will demonstrate the antithrombotic efficacy, bleeding risk, effect on mortality and patient compliance associated with these drugs.

Potential role of plasma myeloperoxidase level in predicting long-term outcome of acute myocardial infarction.

We investigated the prognostic importance of plasma myeloperoxidase levels in patients with ST-elevation myocardial infarction (STEMI) at long-term follow-up, and we analyzed the correlations between plasma myeloperoxidase levels and other biochemical values. We evaluated 73 consecutive patients (56 men; mean age, 56 ± 11 yr) diagnosed with acute STEMI and 46 age- and sex-matched healthy control participants. Patients were divided into 2 groups according to the median myeloperoxidase level (Group 1: plasma myeloperoxidase ≤ 68 ng/mL; and Group 2: plasma myeloperoxidase > 68 ng/mL). Patients were monitored for the occurrence of major adverse cardiovascular events (MACE), which were defined as cardiac death; reinfarction; new hospital admission for angina; heart failure; and revascularization procedures. The mean follow-up period was 25 ± 16 months. Plasma myeloperoxidase levels were higher in STEMI patients than in control participants (82 ± 34 vs 20 ± 12 ng/mL; P = 0.001). Composite MACE occurred in 12 patients with high myeloperoxidase levels (33%) and in 4 patients with low myeloperoxidase levels (11%) (P = 0.02). The incidences of nonfatal recurrent myocardial infarction and verified cardiac death were higher in the high-myeloperoxidase group. In multivariate analysis, high plasma myeloperoxidase levels were independent predictors of MACE (odds ratio = 3.843; <95% confidence interval, 1.625-6.563; P = 0.003). High plasma myeloperoxidase levels identify patients with a worse prognosis after acute STEMI at 2-year follow-up. Evaluation of plasma myeloperoxidase levels might be useful in determining patients at high risk of death and MACE who can benefit from further aggressive treatment and closer follow-up.

The Relationship of Serum Soluble Fas Ligand (sFasL) Level with the Extent of Coronary Artery Disease.

Fas/Fas ligand system contributes to the programmed cell death induced by myocardial ischemia. We investigated whether serum soluble Fas ligand (sFasL) level is independently related with the severity and extent of angiographically assessed coronary artery disease (CAD). We included 169 patients in this study. Two groups were formed based on the existence of a lesion on coronary angiography. First group included patients with normal coronary arteries (NCA; n = 53). Patients with atherosclerotic lesions were included in the second group (n = 116). We used the coronary vessel score (the number of the coronary arteries with a lesion leading to ≥ 50% luminal obstruction) and the Azar score to determine the extent and the severity of CAD. Standard enzyme-linked immunosorbent assay kits were used to measure serum sFasL levels. The serum sFasL level was higher in patients with CAD than in patients with NCA (0.52 ± 0.23 mU/mL vs. 0.45 ± 0.18 mU/mL, p = 0.023). The sFasL level correlated with Azar score (r = 0.231, p = 0.003) and with coronary vessel score (r = 0.269, p < 0.001). In the multivariate analysis, we found that age (beta: 0.188, p = 0.008), gender (beta: 0.317, p < 0.001), diabetes mellitus (DM; beta: 0.195, p = 0.008), and sFasL level (beta: 0.209, p = 0.003) were independently related with Azar score. When we used coronary vessel score as the dependent variable, we found that age (p = 0.020), gender (p < 0.001), DM (p = 0.006), and sFasL level (p = 0.001) were independent predictors. Serum sFasL level is associated with angiographically more severe CAD. Our findings suggest that sFasL level may be a biochemical surrogate of severe coronary atherosclerosis.

Assessment of right ventricular functions during cancer chemotherapy.

AIMS: Although systolic and diastolic left ventricular functions after cancer chemotherapy are well studied, there are a few investigations about the right ventricular functions. We aimed to investigate the early effects of chemotherapy on right heart, if any, in addition to the association between N-terminal pro-brain natriuretic peptide (NT-proBNP) and right heart echocardiographic indices. METHODS AND RESULTS: Thirty-seven consecutive patients with newly diagnosed breast cancer who were planned to receive either AC protocol [cyclophosphamide (600 mg/m(2)) + adriamycin (60 mg/m(2))] or CAF protocol [cyclophosphamide (600 mg/m(2)) + adriamycin (60 mg/m(2)) + 5-fluorouracil (600 mg/m(2))] for six cures were enrolled between February 2009 and June 2010. Echocardiography was performed before the onset of the chemotheurapeutic regimen (T1), on the day after the completion of the first cure (T2), and after the completion of two cures of the regimen (T3). Serum NT-proBNP levels were also measured at T1, T2, and T3. The mean right ventricular fractional area change (RVFAC) was 63.7 ± 3.63, 63.3 ± 3.67, and 61.2 ± 4.41% at T1, T2, and T3, respectively (pT1-T3 and pT2-T3 <0.05). Tricuspid annular plane systolic excursion (TAPSE) has decreased in time (1.82 ± 0.2, 1.78 ± 0.19, and 1.62 ± 0.24 cm; pT1-T2, pT1-T3, and pT2-T3 were 0.002, <0.001, and <0.001, respectively). Tricuspid annular mean E'/A' ratios were 1.42 ± 0.16, 1.36 ± 0.18, and 1.11 ± 0.32 (pT1-T2 = 0.013, pT1-T3 < 0.001, and pT2-T3 < 0.001). Mean tricuspid annular systolic velocities were 11.35 ± 1.85, 11.0 ± 1.82, and 10.45 ± 1.75 cm/s for T1, T2, and T3; and the differences between T1 and T2, T1 and T3, and T2 and T3 were all significant (P = 0.005, <0.001, and 0.001). Median serum NT-proBNP levels were 82 (60-247), 116 (60-426), and 170 (60-600) pg/mL at T1, T2, and T3. The amount of change in RVFAC and TAPSE between T1 and T3 were found to be correlated with the amount of change in NT-proBNP measurements between T1 and T3 (R: -0.7, P < 0.001; R: -0.62, P < 0.001). CONCLUSION: There is a subclinical decrease in right ventricular systolic and diastolic echocardiographic indices, although mostly, in the normal range, in a relatively short time interval after onset of chemotherapy.

The impact of dialysis type on biomarkers for cardiovascular diseases.

OBJECTIVES: The impact of dialysis type on the biomarkers that reflect the severity of cardiovascular diseases is not clearly known. We aimed to investigate the effect of dialysis type on biomarkers of cardiovascular diseases in patients with end-stage renal disease (ESRD). STUDY DESIGN: The study included 108 patients who had been on dialysis treatment (57 patients receiving hemodialysis, 51 patients receiving peritoneal dialysis) for ESRD for at least three months. Blood samples were collected just after the dialysis. Serum N-terminal prohormone of brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), cardiac troponin I (TnI), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and plasma fibrinogen levels were measured and compared between the two dialysis groups. RESULTS: The two dialysis groups were similar with respect to age and gender. The frequency of hypertension was significantly higher in patients receiving peritoneal dialysis. This group also had higher total cholesterol, HDL cholesterol, LDL cholesterol, and hemoglobin levels. Serum levels of NT-proBNP, hs-CRP, IL-6, and TNF-α, and plasma fibrinogen levels were similar in the two dialysis groups (p>0.05), but TnI was significantly higher in patients receiving peritoneal dialysis (p=0.04). Comparison of the patient subgroups based on the duration of dialysis (<12 months, 12-36 months, and >36 months) showed that longer dialysis duration was associated with significantly lower values of NT-proBNP, TNF-α, and hs-CRP (p<0.05). CONCLUSION: The dialysis type does not affect serum NT-proBNP, hs-CRP, IL-6, TNF-α, and plasma fibrinogen levels, but TnI level is higher in patients treated with peritoneal dialysis.

The relationship of serum erythropoietin level with coronary collateral grade.

BACKGROUND: Erythropoietin has been shown to induce neovascularization and protect against ischemic vascular injury. We investigated whether a higher serum erythropoietin (EPO) level is related to better coronary collateral vessel grade. METHODS: Ninety-nine patients with stable angina pectoris who have at least 1 coronary stenosis of equal to or greater than 70% at coronary angiography were prospectively enrolled. Serum EPO and vascular endothelial growth factor (VEGF) levels were studied. Coronary collateral degree was graded according to the Rentrop method. Patients with grade 2-3 collateral degree were included in the good collateral group and formed Group I. The patients with grade 0-1 collateral degree were included in the poor collateral group and formed Group II. RESULTS: The serum EPO level was significantly higher in the good collateral group (17.3 ± 9.3 mU/mL vs 11.7 ± 5.0 mU/mL; P < 0.001). There was also a positive correlation between serum EPO level and Rentrop score (r = 0.39; P < 0.001). In multivariate analysis, serum EPO level (odds ratio [OR] 1.336; 95% confidence interval [CI], 1.120-1.593; P = 0.001), oxygen saturation (OR 0.638; 95% CI, 0.422-0.963; P = 0.033) and presence of chronic total occlusion (CTO) (OR 26.7; 95% CI, 3.874-184.6; P = 0.001) were independently related to well-developed coronary collaterals. CONCLUSIONS: Higher serum EPO level is related to better coronary collateral development. Erythropoietin may have a positive effect on the development of collaterals and may provide a new agent for the treatment strategies to enhance coronary collateral vessel development.

Plasma osteopontin levels in prediction of prognosis in acute myocardial infarction.

OBJECTIVE: We sought to explain the clinical importance of the osteopontin (OPN) in the setting of acute ST-elevation myocardial infarction (STEMI). METHODS: Eighty consecutive patients (55 = 11 years, 12 women and 68 men) and sixty healthy control subjects were included in the study. In all patients, plasma OPN levels were assessed on admission and on the third day (peak value). Creatinine kinase (CK)/CK-myocardial band (MB), troponin I and N-terminal pro-brain natriuretic factor levels and echocardiographic findings were also recorded. Patients were classified into high and low OPN groups according to the median OPN value, and monitored for the occurrence of major adverse cardiovascular events (MACE). RESULTS: Patients with STEMI had higher OPN levels (23.8 [16.7-41.3] ng/ml) on admission than the control subjects (18.0 [11.3-31.5] ng/ml, P = 0.004).The third day value of OPN was significantly higher (39.2 [27.2-56.0] ng/ml) than the OPN level on admission (23.8 [16.7-41.3] ng/ml, P < 0.001). Admission and peak OPN levels were not correlated with CK/CK-MB, white blood cell counts, troponin I and the N-terminal pro-brain natriuretic factor. The plasma OPN levels were not correlated with left ventricular wall motion score index either. In the subgroups of infarct localization and reperfusion strategy, plasma OPN levels were similar. When the patients were compared according to the median OPN values, there were no differences in the occurrence of MACE between the high and low OPN groups. CONCLUSION: This study suggests, for the first time, that the plasma OPN level increases in the first hours of the acute STEMI; however, it could not be used as a prognostic biomarker of STEMI.